Informed consent NCLEX-RN Practice Questions

Informed consent NCLEX-RN Practice Questions

Informed consent is a core legal and ethical responsibility in nursing and a frequent focus on the NCLEX-RN’s Management of Care domain. This topic requires precise understanding of who can consent, what constitutes capacity, the nurse’s role in witnessing and advocacy, and what to do when language barriers, sedation, emergent situations, or minors are involved. These practice questions challenge you to apply principles to realistic scenarios seen in perioperative care, pharmacologic interventions, research participation, blood transfusions, and end-of-life decisions. Each item emphasizes safe delegation, documentation, patient rights, and interprofessional collaboration. Use these questions to deepen your clinical judgment, clarify gray areas, and build exam-ready confidence.

Q1. A client scheduled for laparoscopic cholecystectomy tells the nurse, “I still don’t understand the risks of this surgery.” What is the nurse’s best action?

• Explain the risks in detail and have the client sign the consent
• Ask the surgeon to return and provide further explanation before obtaining the signature
• Ask the charge nurse to witness the consent while you clarify the risks
• Provide a brochure and encourage the client to sign now and read later

Correct Answer: Ask the surgeon to return and provide further explanation before obtaining the signature

Q2. Which statement best describes the nurse’s role when witnessing informed consent?

• Ensuring the provider has fully disclosed all alternatives and outcomes
• Verifying the client’s identity, voluntariness, and apparent capacity when signing
• Explaining risks and benefits not covered by the provider
• Determining whether the procedure is clinically indicated

Correct Answer: Verifying the client’s identity, voluntariness, and apparent capacity when signing

Q3. A non-English-speaking client is scheduled for endoscopy. Which approach ensures valid informed consent?

• Use a trained medical interpreter during the provider’s explanation and consent process
• Ask the client’s teenage child to translate the risks and benefits
• Have the client sign the form; clarify details using pictures afterward
• Proceed with consent because the client nods “yes” when asked

Correct Answer: Use a trained medical interpreter during the provider’s explanation and consent process

Q4. A client received 2 mg IV midazolam for anxiety before signing the consent for colonoscopy. What is the nurse’s priority action?

• Proceed with consent; the dose is low
• Have the client sign and include a note about the medication
• Delay the consent process and notify the provider due to altered cognition
• Ask the spouse to sign because the client was medicated

Correct Answer: Delay the consent process and notify the provider due to altered cognition

Q5. A 16-year-old seeks treatment for a sexually transmitted infection and refuses parental involvement. What should the nurse anticipate?

• Parental consent is required because the client is a minor
• The client may consent for STI evaluation and treatment in many jurisdictions
• A court order is needed before treating without parents
• Only the school nurse can obtain authorization in this case

Correct Answer: The client may consent for STI evaluation and treatment in many jurisdictions

Q6. In an emergency, an unconscious client requires life-saving surgery and no surrogate is immediately available. What principle applies?

• Express consent
• Implied consent
• Assent
• Therapeutic privilege

Correct Answer: Implied consent

Q7. A competent adult Jehovah’s Witness refuses a blood transfusion for symptomatic anemia. What is the nurse’s best response?

• Notify the ethics committee to override the refusal
• Respect the refusal, verify documentation, and notify the provider of alternatives
• Administer blood while the client sleeps to prevent harm
• Request a court order to proceed with transfusion

Correct Answer: Respect the refusal, verify documentation, and notify the provider of alternatives

Q8. During consent for chemotherapy, the client becomes tearful and says, “I feel pressured to do this.” Which action is most appropriate?

• Continue and have them sign since the oncologist already explained
• Pause the process, assess voluntariness, and notify the provider to revisit options
• Ask a family member to encourage the client to sign
• Assure the client that consent cannot be revoked later

Correct Answer: Pause the process, assess voluntariness, and notify the provider to revisit options

Q9. Which client scenario most clearly indicates lack of capacity to consent right now?

• Client oriented to person and place, pain 8/10
• Client slurred speech after receiving IV opioids 5 minutes ago
• Client anxious, asking many questions
• Client with mild hearing loss, using hearing aids

Correct Answer: Client slurred speech after receiving IV opioids 5 minutes ago

Q10. A client with moderate dementia is calm, oriented today, and clearly explains risks/benefits of a minor procedure. The MPOA is unavailable. What is the best action?

• Obtain consent from the client if decision-specific capacity is present
• Delay the procedure until the MPOA arrives
• Ask a neighbor to sign as a witness and surrogate
• Proceed without consent because it is minor

Correct Answer: Obtain consent from the client if decision-specific capacity is present

Q11. The provider explains a bronchoscopy, and the nurse uses teach-back to confirm understanding. Which client response shows readiness to sign?

• “I’ll do whatever you think is best.”
• “This test checks my airways; risks include bleeding and low oxygen, and I can refuse.”
• “It’s routine; there are no serious risks.”
• “My daughter can decide if anything goes wrong.”

Correct Answer: “This test checks my airways; risks include bleeding and low oxygen, and I can refuse.”

Q12. For telephone consent for urgent surgery when the surrogate is off-site, the nurse should:

• Have one licensed witness listen and document the consent
• Obtain two licensed witnesses per policy, read back the consent, and document date/time
• Ask the surgeon’s office to fax a generic consent
• Proceed without consent because it is urgent

Correct Answer: Obtain two licensed witnesses per policy, read back the consent, and document date/time

Q13. Which element is essential for valid informed consent?

• Detailed cost estimate
• Disclosure of risks, benefits, alternatives, and likely outcomes
• A guarantee of success
• A witness who explains the procedure

Correct Answer: Disclosure of risks, benefits, alternatives, and likely outcomes

Q14. A client scheduled for surgery is illiterate. Which action ensures valid consent?

• Have the client mark “X” with two witnesses after the provider’s explanation is read aloud
• Ask a family member to sign for the client
• Proceed with verbal consent without documentation
• Skip consent because literacy is a barrier

Correct Answer: Have the client mark “X” with two witnesses after the provider’s explanation is read aloud

Q15. A client signed consent for a right inguinal hernia repair. Intraoperatively, the surgeon plans to repair an incidental left hernia. What is the correct approach?

• Proceed, as this reduces future risk
• Obtain additional consent if the procedure is materially different and not emergent
• Ask the circulating nurse to consent on the client’s behalf
• Document that the surgeon decided intraoperatively

Correct Answer: Obtain additional consent if the procedure is materially different and not emergent

Q16. The nurse is preparing to give preoperative lorazepam, but notes the consent is unsigned. What should the nurse do first?

• Administer the medication to keep schedule on time
• Hold the sedative and notify the provider to obtain consent
• Ask the family to sign while the client is medicated
• Witness the consent after giving the sedative

Correct Answer: Hold the sedative and notify the provider to obtain consent

Q17. A client with pancreatitis refuses nasogastric tube insertion after consenting earlier. What is the nurse’s best action?

• Explain that consent cannot be withdrawn
• Respect the refusal, assess understanding, notify the provider, and document
• Ask security to assist with insertion
• Call the ethics committee to override the decision

Correct Answer: Respect the refusal, assess understanding, notify the provider, and document

Q18. Which individual is most appropriate to sign for an incapacitated adult without an appointed MPOA?

• Next-door neighbor with long-term relationship
• Adult child as next-of-kin per state hierarchy
• Any hospital staff member not involved in care
• A friend who drove the client to the hospital

Correct Answer: Adult child as next-of-kin per state hierarchy

Q19. A client undergoing a blood transfusion asks, “What are the risks?” Which response reflects the nurse’s role?

• “The provider must explain risks; I will ask them to discuss this now.”
• “There are no risks with modern blood banking.”
• “Just sign, we can explain later.”
• “If you refuse, you can’t receive any treatment.”

Correct Answer: “The provider must explain risks; I will ask them to discuss this now.”

Q20. During informed consent, which communication strategy best supports understanding?

• Use medical jargon to ensure accuracy
• Use plain language and ask the client to teach back key points
• Provide the form without verbal explanation
• Speak quickly to reduce anxiety

Correct Answer: Use plain language and ask the client to teach back key points

Q21. A client intoxicated with a blood alcohol level of 0.18% requires a non-emergent orthopedic procedure. What is the appropriate action?

• Proceed with consent because the client is awake
• Delay consent until sobriety returns and reassess capacity
• Obtain consent from any available friend
• Use implied consent

Correct Answer: Delay consent until sobriety returns and reassess capacity

Q22. A hospitalized client with a DNR is scheduled for elective surgery. What is required regarding consent and code status?

• No action; DNR automatically suspended in the OR
• A discussion with the provider about perioperative goals; document any DNR modification
• Cancel surgery unless DNR is revoked
• Nurse unilaterally decides to suspend DNR

Correct Answer: A discussion with the provider about perioperative goals; document any DNR modification

Q23. Which statement about research consent is accurate?

• Consent is not required if risks are minimal
• Participants must be told they can withdraw at any time without penalty
• Verbal consent is sufficient for drug trials
• Nurses can enroll clients even if the provider is absent

Correct Answer: Participants must be told they can withdraw at any time without penalty

Q24. The provider explained a thoracentesis. The client nods but cannot paraphrase the risks. What is the nurse’s best action?

• Proceed and witness the consent
• Request the provider return to clarify information and reassess understanding
• Ask a family member to explain
• Tell the client the risks are minor

Correct Answer: Request the provider return to clarify information and reassess understanding

Q25. A post-op client consents to clinical photographs for education. What is required to protect rights?

• No additional consent; photos are part of treatment
• Written consent specifying purpose, storage, and de-identification
• Verbal consent with nurse’s note
• Consent from any staff member present

Correct Answer: Written consent specifying purpose, storage, and de-identification

Q26. The provider alters the consent form by crossing out a section and initialing. What should the nurse do?

• Accept the change if initialed
• Request a new, clean consent form to prevent ambiguity
• Proceed and note the alteration
• Photocopy the altered form for clarity

Correct Answer: Request a new, clean consent form to prevent ambiguity

Q27. A client with severe pain states, “I can’t think straight.” Consent for epidural analgesia is pending. What is the best nursing action?

• Proceed with consent because pain is expected
• Manage pain in a way that preserves cognition, reassess understanding, then proceed
• Ask the spouse to sign instead
• Tell the client consent is not needed for pain procedures

Correct Answer: Manage pain in a way that preserves cognition, reassess understanding, then proceed

Q28. Which task related to informed consent is appropriate to delegate to an experienced LPN/LVN?

• Explaining alternatives to the procedure
• Witnessing the client’s signature after RN verifies capacity and voluntariness per policy
• Determining decision-making capacity
• Obtaining surgical consent from the client

Correct Answer: Witnessing the client’s signature after RN verifies capacity and voluntariness per policy

Q29. A parent consents to a child’s surgery; the other parent disagrees at the bedside. What is the nurse’s best initial action?

• Proceed with the surgery because one parent consented
• Pause, notify the provider, and involve case management/ethics per policy
• Ask the grandparents to decide
• Have nursing staff vote on the decision

Correct Answer: Pause, notify the provider, and involve case management/ethics per policy

Q30. A student nurse is asked to witness a consent for central line insertion. What is the appropriate response?

• Agree; any team member can witness
• Decline and notify the RN; witnessing must follow facility policy and scope
• Witness only if the provider is present
• Witness if the client understands

Correct Answer: Decline and notify the RN; witnessing must follow facility policy and scope

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